Radiat Oncol J.  2017 Dec;35(4):306-316. 10.3857/roj.2017.00115.

Prognostic value of nodal SUVmax of 18F-FDG PET/CT in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy

• Lee SJ
• Kay CS
• Kim YS
• Son SH
• Kim M
• Lee SW
• Kang HJ

• KMID: 2401784
• DOI: http://doi.org/10.3857/roj.2017.00115

Abstract

PURPOSE
To investigate the predictive role of maximum standardized uptake value (SUVmax) of 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT).
MATERIALS AND METHODS
Between October 2006 and April 2016, 53 patients were treated with IMRT in two institutions and their PET/CT at the time of diagnosis was reviewed. The SUVmax of their nasopharyngeal lesions and metastatic lymph nodes (LN) was recorded. IMRT was delivered using helical tomotherapy. All patients except for one were treated with concurrent chemoradiation therapy (CCRT). Correlations between SUVmax and patients' survival and recurrence were analyzed.
RESULTS
At a median follow-up time of 31.5 months (range, 3.4 to 98.7 months), the 3-year overall survival (OS) and disease-free survival (DFS) rates were 83.2% and 77.5%, respectively. In univariate analysis, patients with a higher nodal pre-treatment SUVmax (≥ 13.4) demonstrated significantly lower 3-year OS (93.1% vs. 55.5%; p = 0.003), DFS (92.7% vs. 38.5%; p < 0.001), locoregional recurrence-free survival (100% vs. 50.5%; p < 0.001), and distant metastasis-free survival (100% vs. 69.2%; p = 0.004), respectively. In multivariate analysis, high pre-treatment nodal SUVmax (≥ 13.4) was a negative prognostic factor for OS (hazard ratio [HR], 7.799; 95% confidence interval [CI], 1.506-40.397; p = 0.014) and DFS (HR, 9.392; 95% CI, 1.989-44.339; p = 0.005).
CONCLUSIONS
High pre-treatment nodal SUVmax was an independent prognosticator of survival and disease progression in nasopharyngeal carcinoma patients treated with IMRT in our cohort. Therefore, nodal SUVmax may provide important information for identifying patients who require more aggressive treatment.

Keyword

Nasopharyngeal carcinoma; SUV(max); Prognostic factor

MeSH Terms

Cohort Studies
Diagnosis
Disease Progression
Disease-Free Survival
Electrons
Fluorodeoxyglucose F18*
Follow-Up Studies
Humans
Lymph Nodes
Multivariate Analysis
Nasopharyngeal Neoplasms
Positron-Emission Tomography and Computed Tomography*
Radiotherapy, Intensity-Modulated*
Recurrence
Fluorodeoxyglucose F18